Question

A patient who was on steroids presented with nocturnal cough and chronic urticaria. BAL stain was done. Identify the organism.

• A. Strongyloides stercoralis
• B. Enterobius
• C. Ancylostoma
• D. Capillaria philippinensis

Answer 1

The Correct Option is A

The patient described is on steroids, which can suppress the immune system and predispose individuals to certain infections. The symptoms presented include nocturnal cough and chronic urticaria. In such a context, we suspect parasitic infections. Bronchoalveolar lavage (BAL) staining was performed to identify potential pathogens.

The choices provided are:

• Strongyloides stercoralis
• Enterobius
• Ancylostoma
• Capillaria philippinensis

Explanation:

• Strongyloides stercoralis: This is a parasitic worm causing strongyloidiasis, typically associated with immunocompromised patients. The symptoms include cough, urticaria, and gastrointestinal issues. Strongyloides can cause hyperinfection syndrome, especially in steroid-treated patients.
• Enterobius: Known as pinworm, this does not typically cause cough or significant urticaria, and is mostly identified with perianal itching.
• Ancylostoma: These are hookworms, which usually cause iron-deficiency anemia and are less associated with respiratory symptoms.
• Capillaria philippinensis: This results in intestinal infection characterized by diarrhea and abdominal pain, without notable pulmonary or dermatologic symptoms.

Given the patient's treatment with steroids, presence of nocturnal cough, and urticaria, Strongyloides stercoralis is the most consistent organism with the symptoms, especially due to the risk of strongyloidiasis in immunocompromised patients.